Choosing a Medicare Plan for 2027: How to Make Sure You Keep Your Doctor
Every fall, Medicare beneficiaries get a stack of mail, a run of television advertising, and roughly eight weeks to make a decision that governs their health care for the following year.
Most of that material talks about premiums, dental coverage, and gym memberships. Very little of it talks about the thing patients tell us matters most after the fact: whether the doctor they have been seeing for years is still covered on January 1.
This guide is about that question, how to answer it before you enroll rather than after.
What Happens on October 15
Medicare's Annual Enrollment Period runs October 15 through December 7, 2026. Changes you make during that window take effect January 1, 2027.
During AEP you can:
- Join, switch, or drop a Medicare Advantage plan
- Join, switch, or drop a Part D prescription drug plan
- Move from Original Medicare to Medicare Advantage, or back the other way
Two dates worth knowing beyond AEP: if you enroll in a Medicare Advantage plan and it turns out to be a poor fit, the Medicare Advantage Open Enrollment Period from January 1 to March 31 gives you one chance to switch plans or return to Original Medicare. And certain life events, such as moving out of a plan's service area or losing other coverage, open a Special Enrollment Period outside these windows.
Read the Letter That Arrives in September
If you are in a Medicare Advantage or Part D plan, your insurer is required to mail you an Annual Notice of Change by the end of September. It explains what is changing about your plan for the coming year.
Most people skim the premium and set it aside. The sections that deserve more attention are these:
Provider network changes. Plans add and drop physicians, practices, and hospitals every year. A plan that covered your doctor in 2026 may not in 2027, and this letter is the first place that appears.
Formulary changes. Drugs move between cost tiers, and some come off the list. If you take an expensive medication, check it by name.
Cost-sharing changes. Copays for primary care, specialists, labs, and imaging can shift even when the premium stays flat.
If you cannot find the letter, the plan's customer service line will send another. Do not skip this step because the premium looks unchanged, the network changes are the ones that alter your daily life.
Original Medicare and Medicare Advantage Are Different in One Way That Matters Here
Both are legitimate ways to receive Medicare benefits, and each fits a different set of circumstances. But when the question is will I keep my doctor, the structural difference is what determines the answer.
| Original Medicare (Parts A and B) | Medicare Advantage (Part C) | |
|---|---|---|
| Which doctors you can see | Any provider in the country who accepts Medicare assignment | Providers inside the plan's network, which is usually regional |
| Coverage when you travel | Works nationwide | Often limited outside the service area except for emergencies |
| Referrals to specialists | Generally not required | Often required, depending on plan type (HMO vs. PPO) |
| Prior authorization | Rare | Common for imaging, procedures, and some medications |
| Network stability year to year | Stable | Networks are renegotiated annually and can change |
| Extra benefits (dental, vision, hearing) | Not included; may require separate coverage | Frequently included, and a major reason people choose these plans |
Neither column is the right answer for everyone. Medicare Advantage plans bundle benefits many people value and often carry low or zero premiums. Original Medicare paired with a Medigap policy costs more monthly and offers wider access with fewer administrative hurdles. What matters is choosing with the trade-off in front of you rather than discovering it in February.
Why Some Practices Limit Medicare Advantage Participation
Patients ask this often, usually after being told a practice does not take their new plan. It deserves a direct answer rather than a deflection.
Prior authorization. Advantage plans commonly require pre-approval for imaging, procedures, and certain medications. For a practice, that means staff time spent on paperwork and phone queues. For a patient, it means waiting, sometimes days, sometimes longer, for a scan the physician already decided was necessary.
Administrative burden and payment friction. Claims processes, documentation requirements, and denial-and-appeal cycles vary by plan. A small independent practice may be managing a dozen different sets of rules.
Contracting economics. Each plan negotiates its own rates and terms. Some are workable for a small practice and some are not, and participation is a business decision made plan by plan.
Network narrowing by the plan. This runs the other way too. Sometimes a practice wants to participate and the insurer has closed or narrowed the network. Patients often assume their doctor made the choice when the plan did.
None of this makes Medicare Advantage a bad choice. It does explain why the answer to "do you take my plan?" is specific to each plan and each year, and why it has to be verified rather than assumed.
The Checklist: Verify Your Doctor Before You Enroll
Do this before December 7, not after January 1.
1. Call the plan and ask specifically about the 2027 plan year. Provider directories are frequently out of date, and a directory listing is not a guarantee. Ask the representative to confirm participation for the plan year you are enrolling in, and write down the date, the representative's name, and a reference number if one is offered.
2. Call the doctor's office directly and ask the same question. Use the plan's full name, including the plan type, "Aetna Medicare Advantage HMO," not "Aetna." Practices participate in some plans from an insurer and not others, and the distinction between HMO and PPO products from the same company is where most confusion begins.
3. Ask whether they are accepting new patients under that plan. In-network and accepting new patients are two different things.
4. Check your specialists too. Cardiology, endocrinology, nephrology, ophthalmology, whoever you see regularly. A plan that covers your primary care physician may not cover the specialist managing your kidney disease.
5. Check your hospital. Which hospital system a plan contracts with determines where you go for anything serious, and where your physician can admit or follow you.
6. Check your prescriptions by name against the plan's formulary. Drug tiers change annually. Do this for every medication you take regularly, not just the expensive ones.
7. Get the confirmation in writing when you can. Email or a plan portal message beats a phone call you have to remember in March.
Fifteen minutes of calls in October prevents the most common and most painful January problem in Medicare: discovering that a plan chosen for its dental benefit does not include the physician who has managed your diabetes for six years.
If You Have Already Enrolled and Your Doctor Is Not Covered
It is not necessarily too late.
Before December 7, you can simply change your election again, the last choice you make during AEP is the one that takes effect. After January 1, the Medicare Advantage Open Enrollment Period from January 1 to March 31 lets you switch to a different Advantage plan or return to Original Medicare. Certain circumstances, such as a move, may open a Special Enrollment Period.
One caution worth knowing in advance: returning to Original Medicare and buying a Medigap policy later in life can involve medical underwriting depending on your state and timing, which means a Medigap insurer may consider your health history. If you are weighing that path, ask about it before you need it.
How to Change Your Primary Care Physician Under Medicare
Under Original Medicare, there is no assignment and no paperwork. Any physician who accepts Medicare can see you. You call the new office, confirm they are accepting new Medicare patients, and schedule. Requesting your records from the previous practice is the only administrative step.
Under Medicare Advantage, most plans assign or ask you to select a primary care physician, particularly HMO products. Changing usually means calling the plan or updating your selection in its portal, and the change often takes effect the first of the following month. Confirm the new physician is in-network first, then make the change with the plan, then schedule.
Either way, the practical work is the same: request records, bring your medication list, and give the new office your history.
Questions Worth Asking a Practice Before You Commit
- Which Medicare plans do you participate in for the coming plan year?
- Are you accepting new Medicare patients?
- How long is the wait for a new patient appointment, and for a sick visit?
- Is the practice bilingual?
- Do you offer Medicare annual wellness visits, chronic disease management, and remote patient monitoring?
- Which hospitals are you affiliated with?
- Who covers when my physician is unavailable?
The answers tell you more about your next year of care than any plan brochure will.
Medicare Patients at Giraldo Internal Medicine in McAllen, TX
Giraldo Internal Medicine provides internal medicine care for Medicare patients throughout McAllen and the Rio Grande Valley, annual wellness visits, preventive care, chronic care management, and telehealth consultations, all delivered in English and Spanish.
If you are reviewing your options for 2027 and want to know whether we participate in the plan you are considering, call us before you enroll. We will tell you plainly. We are currently accepting new patients.
Giraldo Internal Medicine
1200 Savannah Ave STE 14, McAllen, TX 78503
Phone: (956) 000-0000
Website: giraldointernalmedicine.com
Call us today or visit our website to request an appointment.
Frequently Asked Questions
Q: Do doctors have to accept Medicare Advantage plans?
A: No. Participation in a Medicare Advantage plan is a contractual arrangement between the practice and the insurer, and practices choose which plans to contract with. This differs from Original Medicare, where any physician who accepts Medicare assignment can see any Medicare beneficiary.
Q: How do I find out whether my doctor accepts my Medicare Advantage plan?
A: Verify it twice. Call the plan and ask about the specific plan year, and call the doctor's office with the plan's full name including the plan type. Online provider directories are useful for building a list but are frequently out of date, and a directory entry is not a guarantee of participation.
Q: Why do some doctors not like Medicare Advantage plans?
A: The most common reasons are prior authorization requirements that delay imaging and procedures, the administrative work of managing many plans with different rules, and contract terms that are not workable for smaller practices. It is worth noting that sometimes the plan narrows its network rather than the practice opting out, patients often assume the reverse.
Q: Can my plan drop my doctor in the middle of the year?
A: It can happen, because network contracts can end mid-year. Plans are required to notify affected members, and continuity-of-care protections may apply for a limited period if you are in active treatment. If you receive such a notice, call the plan immediately and ask what your options are, including whether it opens a Special Enrollment Period.
Q: Do I need a referral to see a specialist?
A: Under Original Medicare, generally no. Under Medicare Advantage, it depends on plan type, HMO plans commonly require a referral from your primary care physician, and PPO plans often do not, though staying in-network still costs less. Check your plan's rules before scheduling.
Q: I enrolled in a plan and now my doctor is out of network. What can I do?
A: If it is still before December 7, change your election again. After January 1, the Medicare Advantage Open Enrollment Period from January 1 to March 31 allows one change, to a different Advantage plan or back to Original Medicare. Call your plan and 1-800-MEDICARE to confirm what applies to your situation.
Q: Is Original Medicare or Medicare Advantage better?
A: Neither is universally better, and anyone who tells you otherwise is selling something. Medicare Advantage often includes extra benefits and lower premiums but operates within a network with more prior authorization. Original Medicare with a Medigap policy costs more each month and offers broader access with fewer restrictions. The right choice depends on your health, your medications, your travel, and how much you value keeping a specific physician.
Q: ¿Ofrecen ayuda en español para entender mi plan de Medicare?
A: Sí. Giraldo Internal Medicine is a fully bilingual practice, and our staff can answer questions in Spanish about whether we participate in a plan and what to ask before you enroll. For plan-specific coverage decisions, Medicare also offers Spanish-language assistance at 1-800-MEDICARE, and the Texas Health Information, Counseling and Advocacy Program (HICAP) provides free, unbiased counseling.
References and Resources
- Medicare.gov. Open Enrollment and Joining a Plan. Available at: medicare.gov/health-drug-plans/open-enrollment
- Centers for Medicare & Medicaid Services (CMS). Medicare & You Handbook, 2027 Edition. Available at: medicare.gov/medicare-and-you
- Medicare.gov. Understanding Medicare Advantage Plans and Provider Networks. Available at: medicare.gov/what-medicare-covers
- Kaiser Family Foundation (KFF). Medicare Advantage: Prior Authorization and Network Composition. Available at: kff.org/medicare
- Texas Health and Human Services. Health Information, Counseling and Advocacy Program (HICAP), free Medicare counseling for Texas residents. Available at: hhs.texas.gov
- Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Parts A & B Premiums and Deductibles. Available at: cms.gov/newsroom/fact-sheets
